Provider Demographics
NPI:1366658437
Name:COOPER, LYNN D (MD)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:D
Last Name:COOPER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:14275 MIDWAY RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3614
Mailing Address - Country:US
Mailing Address - Phone:770-951-1793
Mailing Address - Fax:610-271-4245
Practice Address - Street 1:2275 NORTHWEST PARKWAY SE
Practice Address - Street 2:SUITE 140
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-9319
Practice Address - Country:US
Practice Address - Phone:770-951-1793
Practice Address - Fax:770-612-3380
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2015-05-29
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Provider Licenses
StateLicense IDTaxonomies
GA061056207ZD0900X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA268886060AMedicaid
GA460052OtherWELLCARE
GA1366658437OtherTRICARE
GA460052OtherWELLCARE